Contemporary Surgery for Stress Urinary
The Tension-free Vaginal Tape (TVT) procedure is a well-established
surgical procedure for the treatment of female stress urinary
incontinence. The operation, described by Ulmsten in 1996, which is
based on a mid-urethral Prolene tape support, is accepted worldwide as an
easy-to-learn, effective and safe surgical technique. However, typical TVT
operative complications of concern to the operating surgeons include:
bladder penetration, urinary outlet obstruction, potential bowel
penetration, intra-operative bleeding and post-operative infections.
Against this background, Delorme (2001) and de
Leval (2003) were encouraged to design novel mid-urethral slings in the
form of an "out-side-in" and then “inside-out" trans-Obturator TVT-like
procedure. In such, the TVT needle bypasses the retro pubic area, which is
in intimate proximity with the bladder, bowel and blood vessels, by making
the needle route pass through the relatively safe medial compartment of
the Obturator fossa area, remote from the pelvic viscera and vessels.
The TVT-Obturator was shown to be a safe and
easily performed minimally invasive anti-incontinence procedure. The novel
TVT-SECUR and other similar mini-tapes were designed to overcome two of
the peri-operative complications reported with use of the TVT-Obturator:
thigh pain and bladder outlet obstruction.
This was addressed by tailoring the tape to
only 8 cm long and anchoring the tape edges into the internal Obturator
muscle, rather than passing it through the Obturator foramen, muscles and
membrane. The initial pull-out force of the tape and further tissue
ingrowth were studied in the sheep model, revealing satisfactory figures.
The early published data is encouraging in terms of cure rates as well as
safety an simplicity.